Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PSY20249 | CA |
N | 103TC0700X | Clinical Psychologist | PSY20249 | CA |
Y | 103G00000X | Clinical Psychologist | PSY20249 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY20249 | CA |
N | 103TR0400X | Rehabilitation Psychologist | PSY 20249 | CA |
NPI | 1053574871 |
---|---|
Provider Name | Dr. Danielle Aimee Blinstrubas |
First Address | Camp Pendleton, CA 92055-5191 |
Second Address | Oceanside, CA 92058 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2008 |
Last Update Date | 24/03/2011 |